Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe

Abstract

BackgroundRecent research has shown that in schistosome-endemic areas preschool-aged children (PSAC), that is, ≤5 years, are at risk of infection. However, there exists a knowledge gap on the dynamics of infection and morbidity in this age group. In this study, we determined the incidence and dynamics of the first urogenital schistosome infections, morbidity and treatment in PSAC.MethodsChildren (6 months to 5 years) were recruited and followed up for 12 months. Baseline demographics, anthropometric and parasitology data were collected from 1502 children. Urinary morbidity was assessed by haematuria and growth-related morbidity was assessed using standard WHO anthropometric indices. Children negative for Schistosoma haematobium infection were followed up quarterly to determine infection and morbidity incidence.ResultsAt baseline, the prevalence of S haematobium infection and microhaematuria was 8.5% and 8.6%, respectively. Based on different anthropometric indices, 2.2%–8.2% of children were malnourished, 10.1% underweight and 18.0% stunted. The fraction of morbidity attributable to schistosome infection was 92% for microhaematuria, 38% for stunting and malnutrition at 9%–34%, depending on indices used. S haematobium-positive children were at greater odds of presenting with microhaematuria (adjusted OR (AOR)=25.6; 95% CI 14.5 to 45.1) and stunting (AOR=1.7; 95% CI 1.1 to 2.7). Annual incidence of S haematobium infection and microhaematuria was 17.4% and 20.4%, respectively. Microhaematuria occurred within 3 months of first infection and resolved in a significant number of children, 12 weeks post-praziquantel treatment, from 42.3% to 10.3%; P<0.001.ConclusionWe demonstrated for the first time the incidence of schistosome infection in PSAC, along with microhaematuria, which appears within 3 months of first infection and resolves after praziquantel treatment. A proportion of stunting and malnutrition is attributable to S haematobium infection. The study adds scientific evidence to the calls for inclusion of PSAC in schistosome control programmes.

The gut microbiome but not the resistome is associated with urogenital schistosomiasis in preschool-aged children

“…Sixty-eight (60.2%) and 45 (39.8%) children were from Chihuri and Mupfure villages, respectively. Antimicrobial use data showed that 58 (51.3%) participants had received antibiotics [amoxicillin (31), co-trimoxazole (27), both (9)], while 18 (15.9%) had not; no information was obtained for the remaining 37 (32.7%) participants. Previous history of praziquantel treatment (for schistosome infection) was reported among 29/105 (27.6%) children.…”

“…Diet comprised mainly of traditional maize flour porridges (97%; 96/103), the commercial Cerelac® porridge (1.9%; 2/103), and potatoes (1%; 1/103). Anthropometric measures, adjusted for age, were used to assess nutritional status 27 . Based on the weight-for-height Z scores (WHZ), 3.7% (4/107) of individuals were malnourished and 14.7% (16/109) were stunted, based on the height-for-age Z scores (HAZ) 52 .…”

“…Pathology from the disease is mostly from immunological reactions to trapped eggs attempting to migrate through to the bladder or intestinal lumen, depending on the species involved. The infection causes immunomodulatory effects which help to promote both parasite and host survival 24,25 , and in preschool-aged children, consequences can extend to malnutrition, poor growth and cognition, reduced vaccine efficacy, and altered prognosis of co-infections 26,27 . Treatment for schistosomiasis is through administration of the antihelminthic drug, praziquantel, which is effective against all schistosome species 28 .…”

Polyparasitism in School-Aged Children Living in the Schistosomiasis Endemic Focus of Muyuka-Cameroon after &gt;8 Years of Sustained Control Measures: A Cross Sectional Study

“…Although the directionality of causality of these morbidities are not very speci c, microcytosis have been previously associated with protection against erythrocytic stage Plasmodium infection and severe malarial anaemia [68,69]. On the other hand, the growth faltering and malnutrition attributed to urogenital schistosomiasis has been linked to chronic anti parasite in ammation which persists during childhood [67,70,71,72].…”

Mapping the Process and the Resources that are Needed to Implement A Praziquantel Mass Drug Administration Program for Children Aged Five Years Old and Below in Resource Limited Settings.

“…PZQ has been used to control schistosomiasis in affected communities through mass drug administration (MDA) [3]. MDA programs have excluded children aged ve years and below based on the misconception that this age group is not exposed to schistosomiasis [10] and also because they do not attend school where the programs focus [11]. Some children in communities where schistosomiasis is endemic have been diagnosed for schistosomiasis in their rst year of lif e [10].…”